The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review
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Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE).
To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.
PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched.
We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed.
Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P ≤ .05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates.
Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings.
KEY WORDScomputerized physician order entry clinical decision support adverse drug event
The authors would like to thank Mary Thomson Ph.D. for her assistance with the identification of original investigations for inclusion in our sample and Peter Anderson for his assistance with the manuscript preparation. The study was supported by grants (HS010481 and HS15430) from the Agency for Healthcare Research and Quality, Bethesda, MD, USA.
Conflict of Interest
- 5.Kohn LT. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
- 21.Institute of Medicine. Preventing Medication Errors: Quality Chasm SeriesWashington, DC: National Academy Press; 2007.Google Scholar
- 26.Evans RS, Classen DC, Pestotnik SL, Clemmer TP, Weaver LK, Burke JP. A decision support tool for antibiotic therapy. Proceedings from the 19th Annual Symposium on Computer Applications in Medical Care. 1995:651–5.Google Scholar
- 35.Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. New York: Oxford University Press; 2000.Google Scholar